Advocacy

FORCE advocates for families facing hereditary breast and ovarian cancer in areas such as access to care, research funding, insurance, and privacy.

Advocacy > Issues > FORCE Leads the Charge for Medicaid Coverage of Genetic Testing


Newsflash

3/21/2019
FORCE, with over 300 organizations and institutions, is supporting the Ad Hoc Group’s FY2020 recommendation of at least $41.6 billion in funding for the NIH.

3/19/2019
We signed onto a letter to Rep. Debbie Wasserman Schultz thanking her for her leadership on the PALS Act, preserving mammograms for women ages 40-49.

3/18/2019
FORCE, joined by interested orgs, submitted extensive 
comments
on the USPSTF draft guidelines on BRCA counseling and testing. 

2/19/2019
FORCE and a group of 20 stakeholders met with Medicare to urge continued coverage of genetic testing for all cancer survivors who meet guidelines. 

2/15/2019
The government funding bill President Trump signed into law today contained language directing the FDA to ensure breast density information is included in mammography reports.

1/31/2019
FORCE spearheaded a stakeholder letter to HHS and CMS expressing concern about interpretation of a national policy which places significant limits on hereditary cancer genetic testing under Medicare.

 

FORCE Leads the Charge for Medicaid Coverage of Genetic Testing

Insurance Coverage & Barriers

Overview

Genetic testing for increased susceptibility to breast, ovarian, and other cancers has become the standard of care for prevention and risk management in the U.S. Medicaid coverage of health services, however, is managed independently by each state. Of the 50 state Medicaid programs, only 4—Alabama, New Hampshire, North Carolina, and South Carolina—do not cover genetic counseling and/or testing for inherited genetic mutations such as BRCA1 or BRCA2. FORCE learned that the North Carolina Division of Medical Assistance (DMA) is reviewing its policy on offering genetic testing. We mobilized quickly to write comments and secured the support of over 30 partner nonprofit and medical professional organizations in an effort to encourage NC Medicaid to offer this invaluable service to its enrollees. Read the comments submitted on March 23, 2018.

The vast majority of health insurers see the value of identifying individuals who may carry an inherited genetic mutation that causes increased risk of cancer (if that person meets certain personal and/or family health history criteria). In fact, under the Affordable Care Act (ACA), many insurance plans are required to cover BRCA testing for women who qualify and other specified preventive services with no copay or cost-sharing.

Medicaid and Medicare are not bound by the ACA mandate. Most Medicare regions cover BRCA testing only if a woman has already been diagnosed with cancer. Four regions, representing 19 states, have more expansive policies that include multigene panel testing if more than one mutation may be indicated, as well as testing for men.

FORCE continues to advocate that all Americans—regardless of gender, cancer status, economic situation, or health insurance provider—should have access to evidence-based preventive services including, but not limited to:

We are hopeful that NC Medicaid will institute a policy that includes coverage of genetic counseling and testing for those who should receive it. Moving ahead, we plan to work with the other three state Medicaid programs that currently fail to provide access to cancer genetic services. 

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